MattersHealth coverage:What’s next

by Marcella Durand

Many provisions of the Affordable Care Act will
kick in Jan. 1, 2014, but others
take effect earlier. This means
you should expect some changes
in your health insurance plan as
you enroll or re-enroll this fall.
Here are a few to look for.

Making coverage
understandable

For people who are covered
through an employer’s plan,
the most noticeable change
affecting open enrollment is
the new Summary of Benefits
and Coverage.

The summary, which went
into effect Sept. 23, provides
standardized information about
what a particular plan covers
and how it will work, making
it simpler to compare plans and
understand coverage options
better. “Whatever choices
you are making will be much
clearer,” says Kimberly
Calder, the Society’s director
of Federal Health Affairs and
Insurance Policy.

The summary includes
a glossary (see “Defining
the terms,” pg. 53), a chart
illustrating what the plan covers
and excludes, plus coverage
examples of common medical
conditions. Perhaps most
important, the summary provides

all this in understandable
language with no fine print.

Red flags

Even though the summary
goes a long way toward helping
people understand their
coverage better, Kris Erickson,
senior health insurance manager
for the Society, recommends
that people with multiple
sclerosis be very careful as they
enroll or re-enroll. “Make sure
you take the time to review your
options,” she cautions.

Watch out for:•;Caps;on;prescription;drugcoverage•;No;coverage;of;injectablemedicine•;Co-insurance;instead;ofcopayments“Instead of people paying $30at a pharmacy as a copayment,they may be required to pay 20to 30 percent of a medicationinstead, if the plan stipulatesco-insurance,” says Erickson.“This happens with medicationsin specialty tiers, such asdisease-modifying therapies, alot.” Therefore, if you have thechoice, consider choosing directco-pay. Also examine the plan’sformulary, which lists whichdrugs are covered and forhow much.

Getting credit

The Summary of Benefits is now
included in all private individual
and group plans. However,
employers aren’t required to
offer health insurance. While
larger employers have received
tax advantages for some time
for offering health coverage, and
have generally been more likely
to offer health insurance, there
are some options if yours doesn’t.

“If your employer is a small
business, ask them about the
small-business tax credit,”
Erickson recommends. “As